Endoscopic surgery is a significant method of performing surgical operations and has become the surgical procedure of choice due to its patient care advantages over “open surgery”. A particular type of endoscopic surgery is laparoscopic surgery. A significant advantage of laparoscopic surgery over open surgery is the decreased post-operative recovery time. In most instances, a patient is able to leave the hospital within hours after laparoscopic surgery has been performed, whereas with open surgery, a patient requires several days of hospital care to recover. Additionally, laparoscopic surgery achieves decreased incidents of post-operative abdominal adhesions, decreased tissue damage, decreased post-operative pain, and enhanced cosmetic results. Laparoscopic surgery consequently permits the patient to return to normal activity in a short period of time.
Conventionally, a laparoscopic surgical procedure begins with the insufflation of the abdominal cavity with carbon dioxide. The introduction of this gas into the abdominal cavity lifts the abdominal wall away from the internal viscera. The abdominal wall is then pierced or penetrated with two or more devices known as trocars. A trocar includes a housing assembly, a piercing element referred to as an obturator, and a shaft that extends therebetween. A cannula assembly, having a cylindrical port element, is slid over the shaft. After insertion of the trocar through the abdominal wall of the patient, the obturator is removed by the surgeon while leaving the port element protruding through the abdominal wall. The port element may be fixed in place by using a fascia device, and laparoscopic surgical instruments can then be inserted through the port element to view internal organs and to perform surgical procedures.
Notwithstanding the advantages afforded by laparoscopic surgery, such technique has associated disadvantages. Specifically, the puncture wounds created within the body by the surgeon to gain access to the surgical site are often difficult and time-consuming to close, and can place great demands on the surgeon. Such tasks are made even more difficult when laparoscopic surgery is performed upon obese patients where there is a relatively deep puncture wound formed through a relatively small puncture site or incision. Indeed, the puncture site frequently needs to be enlarged following the laparoscopic procedure to ensure that the site is closed at the interior abdominal wall. In addition, many laparoscopic closure devices are incapable of deploying a suture a sufficient distance about the puncture site to fashion an appropriate closure. Such limited distance fails to sufficiently approximate the peritoneum and fascia surrounding the puncture site sufficiently to form an adequate closure.
One laparoscopic device is that described in U.S. Pat. No. 6,743,241 by Stephen Kerr, entitled, “Laparoscopic Port Site Fascial Closure Device.” The stated device allows a surgeon to selectively deploy needles for positioning and stitching a suture across the puncture site that can ultimately be withdrawn from the puncture wound. Although the stated device has allowed for the deploying of a suture without the enlargement of the puncture site. The stated device also has associated disadvantages. In order to utilize the stated device the obturator and the cannula must be removed from the puncture site. This removal can cause temporary loss of the puncture site and/or some difficulty in the reinsertion of another cannula that is associated with the closing device. The removal of the first cannula also has time loss associated therewith.
Another disadvantage associated with the stated device is the inability to determine the extent of the penetration of the suturing needles into the peritoneum and fascia. Not knowing the penetration depth and the relation thereof to the thickness of the peritoneum and the fascia can result in a poor suture that may partially or fully open.
In addition, the stated device is use limited. The stated device is utilized solely for closure of a penetrated site and can only be used after there is no longer surgical use for the penetrated site and a decision is made to close the site.
Thus, there is a need for an improved laparoscopic technique and device for laparoscopic fascial closure that overcomes the above-stated disadvantages.